Healthcare That's Unhealthy?

Health Stats Table as a Blog Post

2009-08-16T12:26:00.000-07:00

I thought I would present some health care statistics in a handy table. All data is from the World Health Organization.

I was quite surprised to find that the under 5 mortality rate in America is twice what it is in Spain. Unless my math is mistaken, this means children in America are twice as likely to die before they reach the age of 6, even though America spends three times as much on health care.

Here's another chart that I find revealing:

More Government Health Care Facts for Those Who Like the Truth

2009-08-16T09:07:00.000-07:00

So, here are some actual facts to consider. In Britain, which is apparently the most despised example of evil Orwellian government health care that the opponents of government health care can think of, people are free to buy and use private health insurance for private health care. I know quite a few British people who do this. These are not people who make things up.

Britain's NHS sees one million people every 36 hours and 93 per cent of patients rate their care as good or excellent.
The CIA says that Brits can expect to live longer under government health care than Americans can under the current free market system: http://ff.im/6zU3G
Measured as a percentage of GDP, Britain spends about half of what America spends on health care, yet Britain enjoys greater life expectancy, lower infant mortality, lower maternal mortality.
My 80 year-old mother lives in Britain and has never experienced age-related government health care restrictions.
The World Health Organization ranks Britain's health care as 18th in the world, while the US is in 37th place.

In other words, Britain, along with many other countries, has figured out how to get better health care results while spending a less than America does. Indeed, Spain has even better outcomes than Britain and spends even less.

So, there is no reason that America can't cut medical spending while improving health care. Okay, well there are reasons. I think they are excess profit and inefficiency.

Just the Facts? The CIA, Stephen Hawking, and the government health care option

2009-08-15T11:15:00.000-07:00

I had almost abandoned this blog...as 2007 wore on it looked more and more like health care reform in America was just a fading dream. Then came 2008 and candidate Obama. Health care reform went from "distant hope" to solid plank in a triumphant campaign platform. No need to blog about health care reform if it was now a presidential mandate. Then came the reality of extremism, people prepared to twist and distort reality to scare up opposition to health care reform, particularly an expanded government health care option.

(For the record: All Americans already have a government health option if they become physically disabled or poor, it's called Medicaid.)

These opponents of an extended U.S. government health care option are not content to say "I am happy with my private health insurance and don't want change." Instead these people had to make things up. And America's ethically bankrupt mainstream media seems prepared to give voice to these fabrications. Blogging to deconstruct these fabrications is now imperative.

Consider Investor's Business Daily. In an attempt to articulate the argument that Americans should not adopt the same kind of government health care that has existed for over 50 years in the United Kingdom, IBD actually printed this: "Stephen Hawking wouldn't have a chance in the UK."

There is zero basis in fact for this statement, but worse than that, the statement is the exact opposite of the truth. For many decades the UK's government health care option, the National Health Service, has provided Stephen Hawking with great care, at no cost. Indeed, Stephen Hawking, one of the world's most celebrated scientists, was moved to make a statement to the press. He said: "I owe my life to the NHS."

So, here is the strategy adopted by opponents of government health care in America: "Make false and alarming statements about how bad things will be if there is an expanded government health care option in America. Make these statements as often and as loudly as you can. Don't worry about the truth at this point because the ends [killing an expanded government health care option] justify these means."

Health Care Dollars: Got your missing billions right here

2007-01-15T17:43:00.000-08:00

Further evidence today to support my theory that the free market is an inefficient provider of health care. Happened on a short article in today's business section of the Florida Times Union. Just a one page piece about a small local company, E&S, with operations mostly located in Amelia Island and seven employees. What do they do? They work on behalf of hospitals to collect money that insurance companies owe them (and would not pay them without prompting--keeping that money to themselves). E&S has just five clients right now. Pretty small stuff huh?

Well consider this, last year the company identified about $850 million in under-reported claims for its clients. That's right $850 million! For just 5 clients! Using just 7 people! The implications are many and some of them are amazing. The cynic in me wants to buy stock in E&S because you just don't see many business models this good (the company had revenues of about $1 million per employee, taking a 25% cut of the amount collected for clients).

But think of how much waste this implies. There are about 6.000 hospitals in America. Some 3,000 are medium to large hospitals (100 or more beds). There are 900 with over 300 beds. Even if we assume that the 5 clients of E&S each have 4 large hospitals the math is pretty staggering: Over $120,000 in uncollected insurance money per hospital bed. There are about 950,000 hospital beds in American hospitals. Total uncollected insurance money could easily top $100 billion.

What a waste!

Black White Gap Widens in Some Areas: Black infant mortality higher now than in 1946

2006-12-26T19:53:00.000-08:00

One of my favorite columnists is Tonyaa Weathersbee in the Jacksonville Times Union. She is determined not to let anyone forget the facts. Like these:

In 1943, black babies died at a rate that was 87 percent higher than white babies. Last year [2005], black babies died at a rate that was 122 percent higher than white babies.

Until Katrina, it was hard for most Americans to picture what life was like for black folk in the Southern states. From what I've seen, it's not healthy, that's for sure.
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Death Rating of Doctors Hurting Healthcare? Study highlights complex issue

2006-12-12T10:02:00.000-08:00

The statement of purpose for this blog pulls no punches. From my choice of words the reader can easily deduce that I am "mad as hell" and often ask myself how much more I can take. However, I fully recognize that the challenge of improving health care is, like most challenges we face today, complex and far from clear-cut. Sure, there are some things that ARE clear, at least IMHO, starting with television adverts for drugs. They don't help anyone but the shareholders of drug companies. Drug ads on TV should be banned. The laws that prevented them for so many decades should re-applied. Period. Do a little free reading here if you doubt this or dig into some of the scientific papers here.

But other issues are less clear cut. For example, should the public have access to a doctor's 'stats' such as survival rates for individual surgeons. This sounds like it might be a good idea. If I was about to have major surgery I would like to get some assurance that the doctor wielding the knife had a good track record. Indeed, a good friend of mine is facing hip surgery and found a set of stats in USAtoday that gave him pause. He was going to have the surgery done at Flagler Hospital in Saint Augustine, but Flagler only got one star in the ratings he found on the web, versus four stars at the hospital he chose instead. However, these ratings are tricky. Consider this chart. Flagler gets three stars for 2007, an improvement over one star for 2006.

Not knowing who or what stats to believe is only part of the problem. Consider this story in the Boston Globe about death rating doctors. And now consider this comment by Twila Brase, president of the Citizens' Council on Health Care:

"Physician report cards threaten patient access to medical treatment. Doctors who fear that the death of a patient will be a black mark against them have been found to avoid the patients that need them the most. Increasingly, patients may find doctors unwilling to try a risky procedure that could actually save them."

I don't always agree with Twila, but have remained on her mailing list because she often highlights the other side of the coin, so to speak. The CCHC web site is certainly worth a look.

As for the answers, well it seems to me that under a free market system anyone can get a good rating for their product or service, they just have to find the right rating entity, and invent one if there is not a pliant one to be found. Wouldn't a government rating system be better? After all, we get government crash test ratings for our cars. And would it not be better for those ratings to apply to a surgical practice as a whole, rather than single out individual doctors? Further research on the effect that Twila highlights is clearly needed.
--S--

More About Racial Inequality in Healthcare

2006-11-13T14:20:00.001-08:00

I found this Newsweek article interesting for the comments people made. You can see that there are some pretty heartless souls out there, as well as some more mindful and prepared to take the time to try and educate their fellow citizens. One comment points to this very useful set of resources based on the Institute of Medicine's report: Unequal Treatment, Confronting Racial and Ethnic Disparities in Healthcare. This was published in 2002 and the basic finding was that

a consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.

I think there will be several reports in 2007 that ask "How far have we come in five years?"
--S--

Racial inequality in healthcare

2006-11-06T07:50:00.000-08:00

Even when enrolled in identical Medicare health plans, black patients have worse health outcomes than white patients, according to a study by researchers from Harvard and Brown universities, who studied data from 431,573 patient visits covered by 151 Medicare managed care plans from 2002 to 2004. The findings appear in the Oct. 25 issue of The Journal of the American Medical Association (as reported by WebMD).
--s--

The Lost Month: Migraines take a toll

2006-11-04T09:28:00.000-08:00

"Businesses lose approximately $13 billion per year due to migraines, according to a study published in the April 1999 issue of the Archives of Internal Medicine. In addition, the National Headache Foundation estimates 157 million workdays are lost annually because of the pain and associated symptoms of migraines."

If you suspect, as many Americans do, that drug companies are not interested in curing illness, merely treating it--with perpetual cycles of expensive newly-patented drugs, then migraine would be the place to start looking for evidence. My wife has suffered from migraines for 40 years. They have now reached a level of frequency that renders impossible the type of paid employment she used to take for granted. In other words, migraines have rendered her unable to hold down a job in her field. She is disabled, by migraines.

And nothing that the medical community has done in the last 40 years has helped. Indeed, it is now more difficult and more expensive to get relief from the pain of migraine than it was 40 years ago. Believe me, my wife has not been sitting around waiting for a cure. Whenever she has been well enough she has vigorously pursued every lead, however improbable, in the quest for a cure. On more than one occasion attending physicians have ridiculed her for even mentioning research aimed at a cure.

So where did the last month go? It was spent holding down the fort, coping with a bad cycle of migraines and their fallout for the patient, her work, her family, and her friends. In this we were not alone. All across this country millions of people suffer with this disease, calling in sick, losing work time and personal time, depleting bank accounts with hospital visits and pharmacy bills, and wondering, in the occasional moments of clarity between bouts of pain: why hasn't someone figure out how to fix this?
--s--

Whacking Waste: A Hopeful Sign?

2006-09-27T17:51:00.000-07:00

So, America now has a Healthcare Administrative Simplification Coalition. Anyone who has been to a doctor recently knows administrative simplification is sorely needed. Patients in the "American healthcare system" are already familiar with the endless but very unsystematic duplication of data input, output, and storage. So it is no surprise that a study [conducted by the MGMA Center for Research] recently revealed that "the increasing complexity and redundancy on the business side of healthcare is costing the industry billions of dollars a year." As an example, for a 10-physician medical group, those wasteful ways translate into nearly $250,000 annually.

Much of the waste generated in our system is a result of administrative busywork or redundancies that add no value to the patient, provider or payer, said William F. Jessee, MD, president and CEO of the MGMA. By reducing administrative complexity, we can reduce costs and enhance access to care. Click here for more.

BTW, the new coalition is made up of the American Academy of Family Physicians, the American Health Information Management Association, and the Medical Group Management Association.

One thing healthcare in America has plenty of is organizations with long names. Hopefully they can do something about the mindless mess that free market philosophy has made of health care management.
--s--

Wally World of Wonder Drugs?

2006-09-22T09:38:00.000-07:00

Okay, so I've been griping about the high cost of my blood pressure medication and then Walmart announces $4 drugs. And they are starting this pricing in Florida, where I spend quite a bit of time. Could that solve my problem?

I take six pills every day and they cost me $414 per month. Walmart's pricing would cut that to $24 if, and this is a big IF, the drugs I take were generics. Well, it turns out that two of my pills are generic. A third is a non-generic only because I take a time-release version (adding time release capabilities to a drug is one way that the drug companies extend their patent protection on proprietary drugs--like the time release version of Prozac that Eli Lilly came out with about the time that the original formulation came off patent).

So, it turns out that if I shift to Walmart in January, I could cut my monthly pill bill from $414 to $332, still way out of line IMHO, enough to lease a very nice Nissan.

However, I am seeing my cardiologist next month and will be pressing him for answers about the two most expensive drugs I take, Diovan and Inspra. The latter makes me feel ill (heart palpitations) and I am not taking it right now. (Let me know if you want to buy my excess supply--and if you are the FDA, try prosecuting me for it, the cause of citizens seeking sane health care pricing would love the publicity--middle-aged white arrested for selling heart drug.)

I will also ask my cardiologist what Diovan does for me that a generic cannot. If I could get a generic alternative to Diovan, substitute a generic statin for Lipitor, use something like Tenoric for the Atenolol and Inspira, I would achieve a $20 monthly pill bill at Wally World. Wahoo!

A Mercedes or Meds?

2006-09-20T15:22:00.000-07:00

I just got back from buying a month's worth of drugs at Target. Price tag: $414.00. No, I don't have AIDS or cancer. I don't have diabetes. I am not overweight. I have high blood pressure, described as "essential hypertension" by doctors because they have essentially no idea why my pressure is higher than "normal."

My blood pressure has been on the high side of normal since 1987. For almost two decades I have taken pills every day. The number and price of those pills has risen from one 15 cent pill per day to six pills costing $13.80 per day. I don't feel any better now than I did when I first found out I had high blood pressure.

Of course, those pills might be keeping me alive, but they are also stressing me out. In today's paper I see that I could lease a nice Mercedes or Cadillac for $414 a month. Who knows, driving a nice car might do more for my blood pressure than the pills.

A Nice House or Health Insurance?

2006-09-20T14:26:00.000-07:00

Yet another analyst is trotting out the claim that 17 million Americans who do not have health insurance live in households with annual incomes above $50,000 and "could likely afford health insurance."

Oh yeah? Maybe if they had inherited a house to live in. Devon M. Herrick of the National Center for Policy Analysis should consider this: Coverage for myself and my wife is costing me $1,096 per month, enough to pay the mortgage on a median-priced home in many cities in this country.

Don't believe me? Well the National Association of Realtors provides handy charts of median home prices. Suppose you and your spouse are both responsible, self-employed, fifty-something professionals. You have decent credit. With a down payment of just $6,000 and a 30-year fixed mortgage at 6% APR you can buy $188,200 worth of house.

That is the median price of a home in the South. You could afford to go above the median price in such desirable locations as Durham (NC), Pensacola (FL), Nashville (TN), and Atlanta (GA). Remember, median means that half of all houses in those places are going to cost less to buy than health insurance.

But what if you are making somewhere in the range of $55,000 per year? If the cost of your health insurance is equal to your mortgage it could disqualify you from buying a house.

Think of it. A nice house or health insurance? Surely that is proof positive something is seriously wrong with health care.

America's Healthcare Crisis

2006-09-14T13:52:00.000-07:00

At the risk of upsetting some people I consider friends, it is high time that I started blogging the unholy, heartless, mindless, money-grubbing mess that is "healthcare" in America today.

For my first post, two connected items. We start with the rate that Blue Cross and Blue Shield are now charging my wife and I for basic health insurance ($1,000 deductible and various other limits): $1096.00 per month. In other words, about the size of a mortgage payment on a median-priced home in this part of the country (North Florida). And we think we are pretty healthy! I have high blood pressure but it is controlled by medication, diet, and exercise. My wife smokes but is trying to quit. She also has migraines (for which the medical establishment has failed to find effective treatment). But we don't have diabetes or cancer or any other serious health conditions, and we take an active interest in staying healthy.

The second item is proof that we are not alone. A report by the Commonwealth Fund, a private foundation that sponsors independent research on health and social issues, reveals that 89% of working-age adults who shopped for health coverage in the individual market over the last three years were rejected for health reasons or found it too expensive.

See: Study Says Individual Insurance Too Costly
by Lisa Girion, Times Staff Writer, September 14, 2006
(may requires registration, but I find the LA Times do not spam registrants)

The full report is available as a Adobe Acrbat pdf here. I urge you to read it. The health of the nation and its citizens is clearly at risk.